Time to replace outdated hardware in sterile operating spaces, and improve usability for medical staff.

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So our surgical teams have long been dependent on older, Windows XP laptops for use in the sterile OR's. There are no physical drops in these areas, so previous techs recommended 15" laptops, and hooked them into the wireless network.

These systems have been in use for about 6 years now - they were purchased with Windows 7, and then inexplicably rolled back to Windows XP. I can only theorize that the tech who did this was preferential to that OS. However, with aging hardware, and very small screens, this has become a problem for the surgeons and medical techs.

At the request of the surgical director, I dug into possible replacements. Updating the existing laptops was out immediately. Buying an OS license for these systems would only prolong the issues they were having. With the age of these systems, wireless connectivity was also failing (the wifi card in one of them was nearly 8 years old), and I didn't want to have to do this twice.

So I got approval to dig into a full replacement option. I had three major criteria to meet:

1. The systems needed to have high visibility, which meant improving screen size.
2. They needed to have a minimal footprint, so no bulky tower systems.
3. There was no budget for running drops to these areas, so they had to have reliable wireless capacity.

As an additional step, I also wanted to make sure that these systems were hardware/software standardized. The previous systems had been bought as-needed, meaning that the physicians and surgical techs had different resources and different experiences with each system.

Since they were all comfortable by this point, with whatever they had, standardizing and improving their experience seemed a great way to ease the transition to new hardware. I also wanted to minimize troubleshooting issues, since these were going into sterile spaces. Remote management and access was my preferred option for software, and the hardware needed to be resilient. Surgical scrubs are a pain, when you just need to check a power cord, so I didn't want to have to worry about the hardware.

I didn't want to replace these systems with more laptops. While it would have been simpler, I knew that these systems needed at least a 5-year refresh cycle, and I wasn't optimistic about the ROI on most business-class laptops, in this particular environment. Sure, they're durable, but getting them durable AND making sure that the criteria was met, was going to hit my budget pretty hard.

I checked with the surgeons, to determine screen sizing and needs, and eventually settled on a 23" monitor for all devices. This was big enough for them to see while working, while remaining lightweight enough for the next step of my plan.

Since these systems needed to be somewhat mobile, and since surgical spaces tend to be very much "in-motion", I couldn't just get an AiO system. The surgeons needed to be able to see it from wherever they were in the room, and the surgical techs needed to be able to access it around other equipment that may be present.

Since I'd managed to keep the monitor weight down, by finding some nice ASUS flatscreens, I decided to wall-mount these systems. With a good anchor point, and reasonable swing arm assembly, the whole thing could be shifted as necessary. It could also be moved quickly out of the way, if an urgent situation arose.

With VESA mounts on the monitors, I had two parts of the solution. The wall-mount systems included a fold-up keyboard tray, so now I just needed the guts - the computer itself. I didn't want to set anything below the wall mount or bolt parts to the wall. The vendor for our wall-mounts, Ergomart, had a nice, universal VESA bracket for Mini-Form-Factor (MFF) computers. That drove my decision to pick up a set of HP ProDesk 600 G1 MFF systems for these mounts. With the reasonable cost, 3/3/3 warranty, and ability to keep everything right behind the monitor, it worked out splendidly.

An addition to this plan struck, when the surgeons requested an additional workstation in the sterile corridor outside the OR spaces. Fortunately, this didn't need to meet the same criteria. I did want to keep screen sizing identical, however, so I flagged a 23" HP AiO for this spot, and the surgeons approved. This also kept me from going over budget; a full wall-mount would have pushed me over at this point.

With parts identified, and approval in hand, the order was placed. Coordination was needed, to do the install during downtime. The surgical director arranged for a carpentry team to do the wall mounts - can't have these falling on a patient - and necessary cleanup for the spaces.

We scheduled the install out about 2 weeks from the parts arrival, and verified that everything was present. I did have to followup on some minor components from Ergomart, but their support was fantastic. I had replacements for a few bolts that hadn't initially shipped, within 48 hours.

The MFF systems were imaged, and setup was performed offsite. I kept them on wireless, to test throughput during this time, and had no issues at all. Bandwidth tests were triple what the old laptops had been getting, and rock solid.

Install day, I had all the systems prepped, monitors pre-mounted, and the wall-mount assemblies were put together. The carpentry team got the wall anchors bolted in, and the remaining parts were dropped into place quickly. Final tests were run, cable management was managed, and the surgical director was set loose on one of the systems to make sure all site-specific items were available to their satisfaction (printers, drives, and the like).

The additional AiO unit was brought in at the same time, and we decommissioned the remaining laptop in the sterile corridor. This left us with all new units, fully installed and functioning, to start on the following Monday.

Over the following week, I kept tabs on the systems, and checked periodically with the surgical techs for feedback. There were some minor teething pains, as one of the swing arms was too tight, and one of the keyboards wasn't quite the height they wanted, but those were quickly remedied.

My final snag came towards the end of the following week. I arrived on a Thursday, to find emails complaining that one of the systems wasn't turning on. Since they're all set to power-cycle overnight, they *should* be online when the staff arrive.

Since the units were identical, I was able to run a few power tests. I eventually narrowed it down to the motherboard itself - BIOS beeps and available test errors isolated a failure in the board. Thankfully, HP's enterprise support, and that 3/3/3 warranty came to my rescue. I was able to get a replacement board from HP by the following Tuesday, which was quickly swapped into the system. After some BIOS recoding for the machine ID, the system came right up. With the drive still intact, I didn't have to do any software reset, so I was able to get them back in operation.

Since then, I have fortunately not had any other hardware issues. All reports have the teams functioning well with these systems, and the surgeons much happier now that they can see reference imaging while they care for patients. I can manage software updates remotely, minimizing the need to enter sterile spaces. Most network updates are run overnight, too, to remove unnecessary load on the network connections during patient care.

I've also documented parts and setup for these components, for the surgical director. This came in handy, as the systems were such a hit, we have another full assembly installed in our pre/post-operative care space, for our nurses. It's been a great experience for the staff, and significantly reduced the number of trouble calls (prior to the upgrade, I was there at least twice a week). Patient care is also seeing a positive impact, as the surgical teams no longer have to struggle to document procedural notes on systems that are dropping network connectivity (or document by hand for later transcription on a system that is behaving).